Comparative Trial Between Sodium Tetradecyl Sulfate and Glycerin in the Treatment of Telangiectatic Leg Veins

BACKGROUND: Thirteen patients were treated with either sodium tetradecyl sulfate (STS) or glycerin to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the relative safety and efficacy of two sclerosant solutions. METHODS: Each patient's leg veins that were from 0.2 to 0.4 mm in diameter and that did not have incompetence from the saphenofemoral junction and whose feeding reticular veins had been already treated in a prior sclerotherapy session were randomly treated with either 0.25% STS or 72% glycerin solution. Patients were evaluated from 2 to 6 months postsclerotherapy for overall clinical improvement and incidence of adverse sequelae. RESULTS: Glycerin was comparable to STS in discomfort of injection but demonstrated a significant decrease in bruising, swelling, and postprocedural hyperpigmentation. Glycerin also demonstrated a better, more rapid clearance of treated telangiectasias. CONCLUSIONS: Seventy-two percent glycerin is a safe and effective sclerosant with fewer side effects and more rapid clearance of telangiectatic leg veins than STS.     

Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial.

OBJECTIVE: To assess the efficacy and safety of sclerotherapy performed with polidocanol foam compared to liquid polidocanol. METHODS: Controlled clinical trial with 1 year follow up in which each patient acted as his/her own control. A total of 75 patients (six men and 69 women) with reticular or postoperative varices were enrolled and sclerotherapy was performed with liquid and with foam (Tessari method) using the same quantity of sclerosant for homogeneous varicose regions, to a total of 150 procedures. The sclerosant concentration was adjusted according to the vein diameter as assess by ultrasonography. The foam group was given 50% lower concentrations of sclerosant than liquid sclerosant group. Clinical assessment (pain, inflammation, pigmentation) and ultrasound examination (diameter of the lumen and length of sclerosed vein) were carried out at 15, 30, 90, and 365 days. RESULTS: Foam allowed complete sclerosis at 90 days in 94.4% of patients compared with 53% for liquid (p<.001) and also allowed a more extensive venous sclerosis (10.1cm compared with 7.2 cm; p<.001). Pain, signs of inflammation, and pigmentation appeared more often with foam sclerosis, with significant difference. The degree of satisfaction was similar for both techniques. CONCLUSIONS: Efficacy of venous sclerosis with foam seems to be greater than with liquid although there is a higher risk of minor secondary effects.     

Stability of Foam in Sclerotherapy: Differences between Sodium Tetradecyl Sulfate and Polidocanol and the Type of Connector Used in the Double-Syringe System Technique

BACKGROUND: Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins. Worldwide, the most popular agents used are sodium tetradecyl sulfate (STS) and polidocanol (POL). The double-syringe system technique to make foam out of a sclerosing solution and air has received wide attention for its ease and reproducibility. This study examined the possibility that the relative silicone content of various disposable connectors may affect overall foam stability. We also evaluated the differences in the stability of foam between STS and POL. MATERIALS AND METHODS: In the first part of the study, one nondisposable stainless steel connector and five disposable plastic connectors were used to create foam from STS 0.50% and air. The procedure was then repeated to produce foam from POL 0.50% and air from each of the six different connector types. As a measure of foam stability, once foam was created with each type of connector, the time required for half of the original volume of sclerosing solution to settle was recorded. In the second part of the study, foam was created with a nondisposable stainless steel connector only and various concentrations of STS and POL. Foam stability was then measured for these different concentrations of sclerosants. RESULTS: The time for sclerosing solution to settle to half of its initial volume was found to vary according to the specific sclerosant and concentration used, with no statistically significant variation based on connector type. CONCLUSIONS: The type of connector used in the double-syringe system technique to produce foam for sclerotherapy is not a factor in foam stability. Sclerosing solutions differ in their foaming stability.     

In vitro effects of detergent sclerosants on coagulation, platelets and microparticles.

OBJECTIVES: To investigate the in vitro effects of Sodium Tetradecyl Sulphate (STS) and Polidocanol (POL) on clotting tests, clotting factors, platelets and microparticles. MATERIALS AND METHODS: Platelet rich (PRP) and platelet poor (PPP) plasmas were incubated with varying concentrations of STS and POL. Clotting tests, platelet/plasma turbidity, and microparticle studies were performed. Specimens were mixed with individual factor deficient plasmas and clotting factor activities were studied. RESULTS: STS at high concentrations (>0.3%) destroyed platelets, microparticles and the clotting factors V, VII and X. It prolonged all clotting tests including prothrombin time (PT), activated partial thromboplastin time (APTT), non-activated partial thromboplastin time (NAPTT), thrombin time (TT), factor Xa clotting time (XACT) and surface activated clotting time (SACT). Higher concentrations of POL were required to achieve some anticoagulant activity. Low sclerosant concentrations shortened XACT and SACT, and induced release of procoagulant platelet derived microparticles. Increased exposure time resulted in increased procoagulant activity. STS at concentrations higher than 0.5% precipitated a complex containing apolipoprotein b and fibrinogen. CONCLUSIONS: Detergent sclerosants affect the clotting mechanism by interfering with clotting factor activities, procoagulant phospholipids and platelet derived microparticles. STS has more anticoagulant activity than POL in high concentrations. Low concentration sclerosants demonstrate procoagulant activity.     

Sclerotherapy of Reticular and Telangiectatic Veins of the Face, Hands, and Chest

BACKGROUND: Prominent tortuous veins of the face and hands may result from the process of aging and constitute a source of distress for many patients. Marked telangiectases of the chest and face are similarly distressing to some patients. OBJECTIVE: To determine the safety and efficacy of sclerotherapy for telangiectatic veins of the face and chest and varicose veins of the hands. METHODS: Twenty facial telangiectases and tortuous veins in 14 patients and 20 total facial sites were treated with sclerotherapy. Patients did not suffer from collagen vascular diseases, had no chronic illnesses, and were thoroughly informed of the strictly cosmetic nature of the procedure. A hyperosmolar sclerosant was used in 16 of 20 sites and the remaining 4 sites were treated with a detergent sclerosant (polidocanol 0.5-0.75%). The follow-up period ranged from 9 months to 15 years. Similarly the varicose veins of 14 hands in seven patients were treated with sclerotherapy using a detergent sclerosant [sodium tetradecyl sulfate (STS)] at various concentrations (1-3%). The follow-up period ranged from 1 to 6.5 years. Tortuous veins and telangiectases on the chest of three patients were treated with either STS 0.25-0.50% or polidocanol 0.75% with a follow-up of 2-9 years. RESULTS: Tortuous facial veins and telangiectases had a mean improvement of 70%, with 11 of 20 sites showing a 90-100% improvement. Hand varicosities had a mean improvement of 97.8%, and all sites showed a 90-100% resolution of varicosities. Finally, the tortuous veins and telangiectases of the chest improved by 50-100% with sclerotherapy. Only minimal to moderate telangiectatic matting was observed in two patients (one in the lateral canthal area and one near the treatment site of chest reticular veins). No ulceration or hyperpigmentation occurred long term in facial or hand veins. One patient developed an arterial ulceration on the left lateral breast. CONCLUSION: Sclerotherapy of varicose and telangiectatic veins of the face, hands, and chest can be safe and effective. Care must be given to sclerotherapy in the chest area, particularly the breast.     

Prolonged myocardial protection with St. Thomas' Hospital solution and University of Wisconsin solution. The importance of preservation techniques.

The effectiveness of University of Wisconsin solution (UWS) and oxygenated St. Thomas' Hospital solution (STS) for prolonged myocardial protection was evaluated in isolated working rat hearts preserved for 12 h at 4 degrees C using three different preservation techniques: induction of cardiac arrest and subsequent hypothermic storage with STS (group 1, n = 9) or UWS (group 4, n = 9), intermittent coronary flush (every 90 min) with STS (group 2, n = 9) or UWS (group 5, n = 9), or continuous coronary perfusion with STS (group 2, n = 7) or UWS (group 6, n = 7) before 60 min of reperfusion. In the UWS preserved hearts, recovery of aortic flow was greater when the simple storage technique was employed compared to intermittent or continuous coronary perfusion (groups 5 and 6). In the STS preserved hearts, aortic flow recovery was superior when the intermittent perfusion technique was applied. The same pattern was observed with regard to recovery of left ventricular pressure. Lactate dehydrogenase release during reperfusion was significantly less pronounced in group 4 (UWS, single flush, simple storage) as compared to group 1 (STS, single flush and simple storage), whereas best preservation of myocardial high energy phosphates was observed when hearts were preserved with multiple dose cardioplegia using STS. Simple hypothermic storage with UWS affords the best functional recovery after prolonged myocardial ischemia in all groups. Repetitive or continuous application of this solution is detrimental, possibly due to potassium overloading. In STS treated groups, multiple dose application of oxygenated STS enhances functional and metabolic recovery compared to its single dose application.(ABSTRACT TRUNCATED AT 250 WORDS)     

A prospective randomized comparison of the Zadik procedure and chemical ablation in the treatment of ingrown toenails

BACKGROUND: We present the results of a prospective randomized trial of the Zadik procedure versus chemical ablation by sodium hydroxide for the treatment of ingrowing toenails. METHODS: Thirty-eight patients had the Zadik procedure, and 45 patients had chemical ablation by sodium hydroxide. Mean followup was 12.45 months for the Zadik group and 11.69 months for the chemical ablation group. RESULTS: In the Zadik group, the average return to normal shoe-wear was 2.13 weeks and in the chemical ablation group 3.73 weeks. Average return to normal activity was 2.18 weeks for the Zadik group and 3.89 weeks for the chemical ablation group. The median number of dressings were 3 and 8 for the Zadik and chemical ablation groups, respectively. The pain score, using the visual analogue scale were not statistically significant between the two groups. The recurrence rates were 23 recurrences in the Zadik group (60.5%) and seven recurrences in the chemical ablation group (15.6%). CONCLUSION: The use of chemical ablation by sodium hydroxide in the treatment of ingrowing toenails shows statistically significant (p < 0.05) reduction in recurrence rates of ingrowing toenails compared to the Zadik procedure.     

Laparoscopic microwave ablation versus percutaneous microwave ablation of hepatic malignancies: Efficacy and recurrence-free survival outcomes in patients

BackgroundHepatic thermal ablation has been found to be effective and equivalent to resection in certain liver histologies. Of the 16,000 annual liver ablations performed in the United States, only 13% (2,080 ablations) are performed laparoscopically. The laparoscopic technique remains underused even with the benefits of improved staging and better access to tumors. The purpose of this study is to compare laparoscopic microwave ablation versus percutaneous microwave ablation in terms of efficacy and recurrence-free survival outcomes in patients with hepatic malignancies.MethodsA comparative analysis was performed on 275 patients (289 ablation procedures) who underwent laparoscopic microwave ablation or percutaneous microwave ablation between February 2011 and May 2021. Ablation success was confirmed postprocedure and recurrence was monitored at follow-up via contrast-enhanced computed tomography/magnetic resonance imaging and/or computed tomography/positron emission tomography.ResultsThe groups were similar for sex, age, body mass index, location of tumor, size of tumor, and number of tumors. Ablation success was 100% in both groups. Local recurrence was significant (5%: laparoscopic microwave ablation vs 22%: percutaneous microwave ablation, P = .002) and same-lobe recurrence (21%: laparoscopic microwave ablation vs 24%: percutaneous microwave ablation) was lower in the laparoscopic microwave ablation group. Median recurrence-free survival was 15.8 months for the laparoscopic microwave ablation group and 5.6 months for the percutaneous microwave ablation group (P = .0002). Overall, 90-day complications were lower in the laparoscopic microwave ablation group (11%) compared with the percutaneous microwave ablation group (21%) (P = .11).ConclusionLaparoscopic surgical ablation is a critical surgical skill that must be taught in fellowship. Laparoscopic microwave ablation leads to better tumor specific outcomes and oncologic outcomes demonstrating clinical efficacy in the treatment of hepatic malignancies compared with percutaneous microwave ablation.     

Injection snoreplasty: investigation of alternative sclerotherapy agents.

OBJECTIVE: Palatal sclerotherapy with sodium tetradecyl sulfate ("injection snoreplasty") was recently introduced as a safe and effective treatment for primary snoring. However, multiple other sclerotherapy agents also have excellent safety records and documented efficacy in the head and neck. Widely available and inexpensive agents were evaluated as potential palatal sclerosing agents for the treatment of snoring. STUDY DESIGN AND SETTING: A described canine palatal flutter model was used to evaluate the palatal stiffening efficacy of ethanol, doxycycline, and hypertonic saline in comparison to 3% sodium tetradecyl sulfate (STS) and a negative control (normal saline). Based on the animal study results, a human pilot study with ethanol was performed with subjective and objective data. RESULTS: Ethanol was found to be equally effective as 3% STS in the canine model. Doxycycline was effective but less so, and hypertonic saline was comparatively ineffective. Palatal injection in human patients with 50% ethanol was found to produce equivalent subjective and objective snoring efficacy and equivalent pain and recovery time compared with 3% STS. However, there was a higher rate of transient palatal fistula with ethanol. CONCLUSIONS AND SIGNIFICANCE: Injection snoreplasty with 50% ethanol is equally efficacious compared with 3% STS. There could be a higher fistula rate with the use of ethanol, although this complication has been self-limited and transient in every case.     

Comparing Consumer-Directed Hospital Rankings With STS Adult Cardiac Surgery Database Outcomes

BackgroundPublic interest in stratifying hospital performance has led to the proliferation of commercial, consumer-oriented hospital rankings. In cardiac surgery, little is known about how these rankings correlate with clinical registry quality ratings.MethodsThe Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for isolated coronary artery bypass grafting or coronary artery bypass grafting/valve patients at hospitals among the top 100 U.S. News & World Report (USNWR) Cardiology & Heart Surgery rankings from 2016 to 2020. Hospitals were grouped into deciles by risk-adjusted observed/expected (O/E) ratios for morbidity and mortality using the STS 2018 risk models. Agreement between STS Adult Cardiac Surgery Database and USNWR ranked deciles was calculated by Bowker symmetry test. The association between each center’s annual change in STS O/E ratio and change in USNWR ranking was modeled in repeated measures regression analysis.ResultsInclusion criteria were met by 524 393 patients from 149 hospitals that ranked in USNWR top 100 at least once during the study period. There was no agreement between USNWR ranking and STS major morbidity and mortality O/E ratio (P > .50 for all years). Analysis of patients undergoing surgery at the 65 hospitals that were consistently ranked in the top 100 during the study period demonstrated no association between annual change in hospital ranking and change in O/E ratio (P all > .3).ConclusionsThere was no agreement between annual USNWR hospital ranking and corresponding risk-adjusted STS morbidity or mortality. Furthermore, annual changes in USNWR rankings could not be accounted for using clinical outcomes. These findings suggest that factors unrelated to key surgical outcomes may be driving consumer-directed rankings.     

异体颗粒状脱细胞真皮基质与自体刃厚皮复合移植修复大鼠皮肤缺损创面效果观察

目的 观察异体颗粒状脱细胞真皮基质(PADM)与自体刃厚皮复合移植修复大鼠皮肤缺损创面的效果.方法 采用随机数字表法将12只SD大鼠分为实验组和对照组,每组6只.于2组大鼠背部制作全层皮肤缺损创面,实验组创面复合移植SD大鼠异体PADM(扩张比10:5)及厚度0.20 mm的自体刃厚皮,对照组创面仅移植厚度0.20 mm自体刃厚皮.术后2周起打开敷料观察大鼠创面愈合情况.术后2、3、4、6、8、12、20周计算2组创面移植皮片成活率、收缩率(或扩张率).术后20周取2组创周正常皮肤及创面皮肤标本,采用HE染色法观察胶原纤维束结构,测量胶原纤维束直径和间隙率;用天狼星红染色法观察Ⅰ、Ⅲ型胶原分布情况,测量Ⅰ、Ⅲ型胶原含量及其比值.对实验数据行独立样本t检验、Levene检验、t'检验.结果 (1)术后2周,实验组大鼠创面移植皮片成活率[(76.1±13.1)%]低于对照组[(94.5±1.3)%,t'=3.440,P=0.018].术后3周,实验组创面移植皮片收缩率[(34±8)%]明显大于对照组[(16±12)%,t=-3.211,P=0.009];术后8周,2组移植皮片扩张率接近一致.(2)HE染色和天狼星红染色显示,与大鼠创周正常皮肤比较,对照组移植皮片胶原纤维束呈均质化改变,胶原纤维纤细,排列紊乱;实验组移植皮片胶原纤维束结构、排列更接近创周正常皮肤,可见未完全降解的PADM.与对照组创面皮肤胶原纤维束直径[(7.3±1.4)μm]、间隙率[(17±4)%]、Ⅰ型胶原含量[(68.1±8.4)%]、Ⅲ型胶原含量[(32.0±8.4)%]以及Ⅰ、Ⅲ型胶原比例(2.3±1.0)比较,实验组胶原纤维束更粗[(9.6±0.8)μm,t=-3.562,P=0.005],间隙率更大[(24±5)%,t=-2.760,P=0.020],Ⅰ型胶原含量更高[(80.2±5.4)%,t=-2.981,P=0.014],Ⅲ型胶原含量更低[(19.8±5.4)%,t=2.981,P=0.014],Ⅰ、Ⅲ型胶原比例更高(4.3±1.2,t=-3.204,P=0.009).实验组创面皮肤上述胶原相关指标更接近于创周正常皮肤水平.结论 异体PADM在体内作为真皮再生模板,有助于改善自体刃厚皮所修复的大鼠皮肤缺损创面中真皮胶原纤维束的结构,提高再生真皮组织的成熟度.

Abstract：

Objective To evaluate the effects of mixed grafting of allogeneic PADM and autologous STS on wound healing of full-thickness defect in rats. Methods Full-thickness defects with size of 6 cm×4 cm were produced on the back of 12 SD rats, and they were divided into E group(n =6) and C group ( n = 6) according to the random number table. The wounds in E group were grafted with a mix of allogeneic PADM (expansion rate 10: 5) and autologous STS with thickness of 0.2 mm, while those in C group were grafted with autologous STS in the same thickness. The wound healing rate, survival rate, contraction rate,and expansion rate of transplanted skin were observed at post operation week (POW) 2, 3, 4, 6, 8, 12,20. Tissue samples form wounds and surrounding normal skin were harvested at POW 20 for histopathological observation as follows. The structure of collagen fiber bundle was observed by HE staining, the diameter and gap rate of collagen fiber bundle were also measured. The distribution of type Ⅰ and Ⅲ collagen was observed by sirsus red staining, and the contents of type Ⅰ , Ⅲ collagen and their ratio were also examined.Data were processed with independent samples t test, Levene test, and t' test. Results Survial rate of transplanted skin in E group at POW 2 [(76. 1 ± 13. 1)%] was obviously lower than that in C group [(94.5 ± 1.3)%, t' =3.440, P =0.018]. Contraction rate of transplanted skin in E, C groups at POW 3 showed significant difference [(34±8)%vs. (16 ±12)%, t = -3.211, P =0.009]. Compared with those in peri-wound normal skin, collagen fiber bundles in C group showed signs of homogenization, and collagen fibers were thin with irregular arrangement. Collagen fiber structure and arrangement of composite skin in E group were similar to those surrounding normal skin with incomplete degradation of PADM. Diameter of collagen fiber bundle [( 9.6 ± 0.8) μm] , gap rate between collagen bundle [( 24±5) %] , content of type Ⅰ collagen [( 80.2 ± 5.4) %] and the ratio of typeⅠto type Ⅲ collagen(4.3 ± 1.2) in E group were all increased as compared with those inC group [(7.3±1.4) μm (t = -3.562, P =0.005), (17±4)%( t =-2.760, P =0.020), (68.1 ±8.4)%(t = -2.981, P =0.014), 2.3±1.0(t = -3.204, P =0. 009)], while content of type Ⅲ collagen [( 19.8 ± 5.4) %] in E group was lower than that in C group [(32.0 ±8.4)% , t = 2. 981, P = 0. 014]. Above-mentioned indexes of collagen in wound of E group were similar to those of normal skin surrounding the wound. Conclusions Allogeneic PADM used as dermal regeneration template is beneficial in improving collagen fiber bundle structure in dermis layer of rats with fullthickness skin wounds when repaired with autologous STS, and it accelerates maturation of regenerative dermal tissue.     

Myocardial revascularization: the evolution of the STS database and quality measurement for improvement

The Society of Thoracic Surgeons (STS) is a not-for-profit organization dedicated to helping clinicians and researchers provide optimal outcomes for patients undergoing heart, lung, and esophageal surgery. The organization was founded in 1964 and has grown to now include over 7300 members in over 90 countries. The STS created a national database that collects detailed clinical information on patients undergoing adult cardiac, pediatric and congenital cardiac, and general thoracic operations. The data collected are used to produce risk-adjusted, nationally benchmarked performance assessments and feedback; facilitate voluntary public reporting; support quality initiatives; develop evidence-based guidelines; monitor long-term clinical outcomes; track device performance; and promote high-quality research collaboratives.     

0.5% polidocanol for treatment of varicose veins

Background: The use of sclerosants approved by the US Food and Drug Administration for treatment of varicose veins, including sodium morrhuate, ethanolamine oleate, and sodium tetradecyl sulphate, has resulted in complications that include allergic reactions and occasional deaths. Polidocanol, which has not been approved by the Food and Drug Administration, has been well studied and well described in the literature as a safer, more effective sclerosant for varicose veins at 3.0% concentration. Objective: The purpose of this study was to examine the efficacy of 0.5% polidocanol as a sclerosant for varicose veins. Methods: A test dose of polidocanol is injected 1 week before the start of treatment to test for allergic response. Sclerotherapy sessions last 10 minutes, and an average of 10 to 20 mL of 0.5% polidocanol is injected through use of 30-gauge half-inch tuberculin syringes. The treated varicosities are compressed with Coban wrap and compression hosiery for 48 hours after treatment and with compression hosiery alone for another 2 weeks. Results: Having performed approximately 1600 sclerotherapy sessions using 0.5% polidocanol over the last 6 years, I have observed that an average of 3 sclerotherapy sessions are required to attain an 80% to 85% improvement in varicose veins. The number of sessions required for successful treatment ranged from 1 to 15. Results have been long lasting. Localized thrombus formation and hyperpigmentation occurred in some degree in every treated patient but generally did not require treatment for resolution. No ulcerations, pulmonary emboli, or anaphylactic reactions were observed. Superficial chemical thrombophlebitis occurred in 3 patients. Conclusions: Polidocanol is a painless, nonscarring, effective treatment for a condition that previously has been treated surgically. The minimal sclerosant concentration for the treatment of varicose veins is 0.5%.     

Predictive Power and Implication of EuroSCORE,EuroSCORE II and STS Score for Isolated Repeated Aortic Valve Replacement

Objective: We evaluated the predictive power of the EuroSCORE, EuroSCORE II and Society of Thoracic Surgeons (STS) score for isolated redo aortic valve replacement.Materials and Methods: 78 consecutive patients underwent the aforementioned procedure mainly with a stentless valve prosthesis at our institution. Observed mortality was compared to the predicted mortality, Receiver Operating Characteristics (ROC) curves were calculated and the area under the curve (AUC) analyzed.Result: Observed mortality was 11.5%. EuroSCORE and EuroScore II predicted a mortality of 28.2 ± 21.6% (p <0.001) and 10.2 ± 11.8% (p = 0.75), respectively. AUC of the EuroSCORE was 0.74 (95% CI: 0.62–0.83), p = 0.009 and of the EuroSCORE II 0.86 (95% CI: 0.76–0.93), p <0.0001. Optimal Youden index of the EuroSCORE II was 0.59 refering to a predicted mortality of 9.9% (sensitivity: 77.8% and specificity: 81.2%). Predicted mortality of STS score was 17.8 ± 10.6% (p = 0.08) and AUC was 0.64 (95% CI: 0.53–0.75), p = 0.06.Conclusion: EuroSCORE II calculation was not only superior to EuroSCORE and STS score but led to a very realistic mortality prediction for this special procedure at our institution. A EuroSCORE II greater 10 should encourage to consider an alternative treatment.     

术中射频治疗在剖胸探查晚期非小细胞肺癌治疗中的作用和意义

目的探讨术中射频治疗在剖胸探查晚期非小细胞肺癌治疗中的作用和意义。方法2002年1月至2004年12月23例剖胸探查无法手术切除的晚期非小细胞肺癌患者行术中射频治疗为治疗组(n=23,A组),同期无法手术切除的晚期非小细胞肺癌30例给予化疗为对照组(n=30,B组),观察术后疗效、疼痛缓解程度、ECOG评分、术后生活质量。结果A组的治疗、疼痛缓解程度、ECOG评分及治疗后生活质量的好转率分别为65.22%、65.22%、60.86%、65.21%;B组为36.67%,33.33%,33.33%,30.00%。射频治疗组优于化疗组。(P<0.05)结论术中射频治疗可有效地提高不可切除的晚期非小细胞肺癌的术后疗效和生存质量,对于晚期非小细胞肺癌提供了新的治疗途径。     

Outcome of ultrasound-guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance.

OBJECTIVE: To estimate medium-term success after a technique for ultrasound-guided sclerotherapy for superficial chronic venous disease. DESIGN: A prospective study in a single unit with ultrasound surveillance after treatment. MATERIALS: Results after 1189 treatment sessions for 807 venous saphenous veins and related tributaries or non-saphenous tributaries in 489 patients. METHODS: Univariate life table analysis determined primary and secondary success rates. Multivariate Cox regression analysis detected covariates that affected outcome. RESULTS: Primary and secondary success rates at 36 months for all veins were 52.4% (95%CI 46-58%) and 76.8% (95%CI 71-82%). Cox regression analysis for primary success for all veins showed significantly worse results for saphenous veins compared to tributaries (HR 3.72 - 95%CI 1.9 to 7.3). Cox regression for all saphenous veins showed independently worse results for patients less than 40 years age (HR 2.16 - 95%CI 1.27-3.66), small compared to great saphenous veins (HR 1.58 - 95%CI 1.11-2.24), veins greater than 6mm diameter compared to smaller veins (HR 2.22 - 95%CI 1.40-3.50), liquid compared to foam sclerotherapy (HR 2.20 - 95%CI 1.28-3.78), lower volumes of sclerosant compared to volumes greater than 12 ml (HR 0.51 - 95%CI 0.33-0.81) and highly diluted compared to concentrated sclerosant (HR 2.05 - 95%CI 1.21-3.46) with worse results using highly diluted or undiluted 3% sclerosant compared to a 1.5% concentration. There were no significant differences for primary success for saphenous veins for date of procedure, sex, side, primary or recurrent varicose veins, or commercial type of sclerosant. CONCLUSIONS: Ultrasound-guided sclerotherapy gives satisfactory results if it is accepted that treatment may need to be repeated to achieve secondary success. Results provide a basis for further research to explore factors that might affect outcome. Younger patients with larger diameter saphenous veins may warrant alternative forms of treatment, particularly for small saphenous reflux.     

Photodynamic therapy using Verteporfin (benzoporphyrin derivative monoacid ring A, BPD-MA) and 630 nm laser light in canine esophagus

BACKGROUND AND OBJECTIVE: Verteporfin is a new photosensitizer with short-term skin photosensitivity. The objective of this preclinical study was to find the light dose that effectively ablates canine esophageal mucosa when delivered 30 minutes after Verteporfin injection. STUDY DESIGN/MATERIALS AND METHODS: Verteporfin was administered intravenously (0.75 mg/kg). 630 nm light from KTP/Dye laser was delivered using an esophageal Photodynamic therapy (PDT) balloon. In Phase I study, animals were treated 30 minutes after drug injection using 40, 60, and 80 J/cm to find the desired light dose. Using results from phase I and application of reciprocity principle (light dose vs. plasma concentration of drug), additional light doses were calculated for delivery at other times. In phase II, animals were treated at 15, 60, and 120 minutes, using the calculated light doses of 60, 145, and 200 J/cm, respectively. Animals were followed for 2 days to 4 weeks. RESULTS: In Phase I, 80 J/cm at 30 minutes induced total mucosal ablation. In Phase II, light doses of 60, 145, and 200 J/cm induced similar mucosal injuries when delivered at 15, 60, and 120 minutes, respectively. CONCLUSIONS: Effective mucosal ablation in canine esophagus was achieved using Verteporfin and 630 nm light doses of 60, 80, 145, and 200 J/cm when delivered at 15, 30, 60, and 120 minutes after the drug injection, respectively.     

Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst

BACKGROUND AND PURPOSE: Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst. PATIENTS AND METHODS: Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months. RESULTS: There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019). CONCLUSIONS: Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.     

经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后比较

目的:比较经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后。方法:回顾性分析2012年1月—2014年12月间收治的140例原发性小肝癌患者资料,其中80例行射频消融术(消融组),60例行腹腔镜肝切除术(腔镜组)。比较两组患者术后血清肝功能指标与肿瘤标志物水平的变化、并发症发生率、根治率、复发率及生存率。结果:术前两组的基线资料、肝功能指标及肿瘤标志物水平均无统计学差异(均P0.05)。术后消融组肝功能指标先升后降,腔镜组则呈持续降低,消融组术后短期内丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平均明显高于腔镜组(均P0.05);两组术后肿瘤标志物水平均逐渐降低,两组间差异无统计学意义(均P0.05)。消融组术后并发症发生率明显低于腔镜组(3.75%vs. 20.00%,P=0.002)。两组根治率、复发率以及1、2、3年总生存率和无瘤生存率均无统计学差异(均P0.05)。结论:两种手术方式对原发性小肝癌的疗效及预后无统计学差异,射频消融术后并发症较少,但对短期肝功能存在一定损害。     

多术式联合治疗T1a期胆囊癌的疗效及安全性分析

目的分析多术式联合治疗T1a期胆囊癌的疗效及安全性。方法回顾性分析2016年1月至2019年1月80例T1a期胆囊癌患者临床资料,将接受完全腹腔镜下胆囊切除+淋巴清扫+射频消融治疗的32例患者纳入腔镜组,将接受开腹胆囊切除+淋巴清扫+射频消融治疗的48例患者纳入开腹组。采用SPSS 21.0软件包进行分析。手术疗效、术后并发症采用χ^2检验;手术相关指标、中国癌症病人生活质量调查问卷(QOL)评分用(±s)描述,采用独立t检验,P<0.05为差异有统计学意义。结果腔镜组手术总有效率(93.8%)略高于开腹组(89.6%),术后并发症总体发生率(6.3%)略低于开腹组(20.8%),但差异均无统计学意义(P>0.05);腔镜组手术时间、术后排气时间、术后住院时间和术中出血量均少于开腹组(P<0.05);腔镜组术后6个月QOL量表中食欲、精神、疼痛、疲乏、日常活动及家人理解度评分均比开腹组高(P<0.05)。结论多术式联合治疗T1a期胆囊癌的疗效相当,但相比开腹组,腹腔组创伤小、出血量低、术后并发症少,且更利于改善生活质量。